Stroke, Vol 23, 657-662, Copyright © 1992 by American Heart Association
T Strand
BACKGROUND AND PURPOSE: In a previous single-center, randomized controlled
trial including 102 patients treated in a stroke unit, we showed that
rapid, modest hemodilution improved short-term clinical outcome in ischemic
stroke patients. I now evaluate the long-term outcome and potential risks
of this combined venesection/dextran 40 therapy in the same 52 treated and
50 control patients. METHODS: Mortality, need for institutional care, and
recurrent strokes were registered during 1 year following inclusion in the
trial, and a final evaluation of functional outcome was performed at 12
months after the stroke. Cerebrospinal fluid was analyzed for protein
content and hemorrhagic admixture at two occasions during the acute phase.
RESULTS: Thirty-six hemodiluted and 30 control patients survived the first
year following the stroke (difference not significant). One year after the
stroke, persistent neurological deficits were less frequent among the
hemodiluted patients and a larger proportion of hemodiluted survivors was
independent in walking (92% versus 73%, p less than 0.05). Two hemodiluted
patients (6%) and nine control patients (30%) were totally dependent in the
activities of daily living (p less than 0.05). Three hemodiluted patients
(8%) and eight control patients (27%) remained hospitalized 1 year after
the stroke (p less than 0.05). With the possible exception of patients with
a medical history of congestive heart failure, subset analyses revealed a
tendency toward improved outcome for hemodiluted patients in all clinically
important subgroups compared with the controls. When analyzing
cerebrospinal fluid, signs of blood-brain barrier breakdown and hemorrhagic
admixture to the cerebrospinal fluid during the acute phase were less
frequent in the hemodiluted subjects. CONCLUSIONS: These results suggest
that, when applied in a stroke unit, the combination of venesection and
dextran 40 administration is a clinically safe, therapeutic regimen in the
treatment of acute cerebral infarction that improves long-term clinical
outcome.
ARTICLES
Evaluation of long-term outcome and safety after hemodilution therapy in acute ischemic stroke
Department of Internal Medicine, University Hospital, Umea, Sweden.
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